Si Young Choi

Short-term and intermediate-term results after unclipping: what happened to primary hyperhidrosis and truncal reflex sweating after unclipping in patients who underwent endoscopic thoracic sympathetic clamping?

Endoscopic thoracic sympathetic clamping (ETC) is used to treat patients with primary hyperhidrosis because it offers the potential of a reversal operation (unclipping) when severe reflex sweating (RS) occurs. Although unclipping has been reported to be effective, the short-term or intermediate-term results after unclipping are unclear. From March 2002 to October 2006, 15 (12.9%) out of 116 patients with primary hyperhidrosis, who underwent ETC, had the endoclip(s) removed as a result of RS. Fourteen patients could be followed up for more than 6 months. The patients answered a telephone interview on the severity of RS, the recurrence of the primary site, and their level of satisfaction. There was no mortality or significant morbidity encountered. On the follow-up, 9 (64%) of the 14 patients who underwent unclipping reported symptomatic recovery from RS. Of these 9 patients with early unclipping (within 4 wk after ETC), only 7 (78%) were satisfied with the outcomes. This suggests that early unclipping does not always guarantee satisfactory recovery from RS. Because early unclipping does not guarantee a full recovery in all patients, special consideration in ETC is needed to determine when to remove the clamp and how strongly to apply the clamp to achieve better results.

What Factors Predict Recurrence after an Initial Episode of Primary Spontaneous Pneumothorax in Children

PURPOSE Recurrence is the most common complication after an initial episode of primary spontaneous pneumothorax (PSP). However, preventive surgery in children remains a controversial issue. The purpose of this study was to determine predictive factors of recurrence to better inform early surgical referrals. METHODS We retrospectively reviewed all consecutive patients under 18 years of age who conservatively treated for an initial episode of PSP between March 2005 and September 2011. RESULTS One hundred fourteen patients were included in this study. The mean follow-up period was 43.1 months. Ipsilateral and contralateral recurrence developed in 47.3% and 14.0% of patients. The risk of ipsilateral recurrence for patients with or without air-containing lesions according to high-resolution computed tomography (HRCT) was 60.3% and 31.4%. In the multivariate analysis, the presence of air-containing lesions on HRCT scans and bullae on chest X-rays were independent risk factors for ipsilateral recurrence. CONCLUSION The presence of bleb or bullae on HRCT scans or chest X-rays after an initial episode of PSP was significantly related to the ipsilateral recurrence in children. If the risk factors are clarified in further studies, hospital stays and the recurrence of PSP after the first episode could be reduced with early video-assisted thoracoscopic surgery.

Risk factors for the development of reexpansion pulmonary edema in patients with spontaneous pneumothorax

BackgroundReexpansion pulmonary edema (REPE) is known as a rare and fatal complication after tube thoracostomy.ObjectivesWe investigated the risk factors for the development of REPE in patients with spontaneous pneumothorax.MethodsWe selected patients who were diagnosed with spontaneous pneumothorax and were initially treated with tube thoracostomy between August 1, 2003 and December 31, 2011. The patients’ electronic medical records, including operative notes and chest x-ray and computed tomography scans, were reviewed.ResultsREPE developed in 49 of the 306 patients (16.0%). REPE was more common in patients with diabetes (14.3% vs 3.9%, P = 0.004) or tension pneumothorax (46.8% vs 16.2%, P = 0.000). The pneumothorax was larger in patients with REPE than without REPE (57.0 ± 16.0% vs 34.2 ± 17.6%, P = 0.000), and the incidence of REPE increased with the size of pneumothorax. On multivariate analysis, diabetes mellitus [(odds ratio (OR) = 9.93, P = 0.003), and the size of pneumothorax (OR = 1.07, P = 0.000) were independent risk factors of REPE.ConclusionsThe presence of diabetes increases the risk of REPE development in patients with spontaneous pneumothorax. The risk of REPE also increases significantly with the size of pneumothorax.

Extrapericardial cardiac tamponade by a retrosternal haematoma after blunt chest trauma

a Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea b Department of Thoracic and Cardiovascular Surgery, Daejeon St. Mary’s Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea c Department of Thoracic and Cardiovascular Surgery, St Paul’s Hospital, The Catholic University of Korea College, College of Medicine, Seoul, Korea

Integration of Gene-Expression Profiles and Pathway Analysis in Ascending Thoracic Aortic Aneurysms

BACKGROUND Despite the increasing incidence of ascending thoracic aortic aneurysms, their pathogenesis and molecular mechanisms remain unknown. The aim of this study was to identify the biological pathways of genes that are expressed differentially in ascending aortic aneurysms. METHODS Aneurysm wall tissues were obtained from thoracic aortic aneurysms during their repair and normal thoracic aortas from organ transplant patients. The differential expression of genes was analyzed by NimbleGen microarrays. The biological pathways and processes were identified using Kyoto Encyclopedia of Genes and Genome pathway analysis and gene ontology analysis. RESULTS Among 45,034 genes, 95 were differentially expressed (>two-fold change compared with control). A total of 76 genes were up-regulated and 19 genes were down-regulated in patients with ascending thoracic aneurysm. Analysis of the Kyoto Encyclopedia of Genes and Genomes pathways revealed 26 biologically functional pathways in the following categories: focal adhesion, cell junctions, peroxisome proliferator-activated receptor signaling pathway, extracellular matrix-receptor interaction, T-cell-receptor signaling pathway, B-cell-receptor signaling pathway, and regulation of the actin cytoskeleton. Differentially expressed genes were associated with 123 different gene ontology biological processes: transport, signal transduction, inflammatory response, chemotaxis, and immune response. CONCLUSION We identified that differentially expressed genes are associated with the pathways that are mainly involved in interactions between cells and the extracellular matrix, and with immune function. The reported data provide useful information on the molecular mechanisms underlying the formation of ascending aortic aneurysms.

Successful Treatment of Catamenial Hemoptysis by Video-Assisted Thoracoscopic Surgery

We report a case of a 23-year-old woman with a 5-year history of recurrent hemoptysis during menstrual period. Catamenial hemoptysis was diagnosed using chest computed tomography and bronchoscopic examination during menstruation. The patient was managed successfully with wedge resection and has been free of recurrence for 5 years. We suggest that surgery is an effective treatment, and complete resection with accurate localization is important for the prevention of recurrence.

Increased Expression of Connexin43 on the Aortic Valve in the Hypercholesterolemic Rabbit Model

Background: Aortic valve sclerosis is associated with increased risk of cardiovascular death and myocardial infarction. However, the relevance of connexin43 in aortic valve sclerosis remains unclear. We hypothesized that the mechanism regulating aortic valve sclerosis is associated with the alteration of cell-to-cell communication. Methods: Twenty male New Zealand rabbits were divided into two groups. Group 1 (n = 10) were fed a normal chow diet, while those in group 2 (n = 10) received a diet containing 1% cholesterol for 12 weeks. After utanizing the animals, the aortic valves were excised for analysis. Results: Myofibroblasts and macrophages were more highly expressed in the cholesterol diet group. Osteopontin and connexin43 were found to concentrate within the endothelial layer on the aortic side of the valve leaflets in the cholesterol diet group. A real-time polymerase chain reaction revealed increased connexin43 and osteopontin mRNA levels in the hypercholesterolemic aortic valves. Conclusions: The present study demonstrates that hypercholesterolemia increases the expression of connexin43 in the rabbit aortic valve. The results suggest that alterations in gap junctional intercellular communication via connexin43 gap junctions may play a role in the development of aortic valve sclerosis.

Anemia resolved by thoracoscopic resection of a mediastinal mass: a case report of unicentric Castleman’s disease

Castlemans disease (CD) is an uncommon benign lymphoproliferative disorder that usually presents as a single or multiple mediastinal mass. In unicentric CD, constitutional symptoms are rare, but are curable with surgical resection. However, serious intraoperative bleeding often requires conversion to thoracotomy. We present a case of unicentric CD in a 25-year-old woman with anemia, who was successfully treated by thoracoscopic resection. We describe the clinical course from the initial presentation to diagnosis and surgical cure.

Primary idiopathic silent chylopericardium

Chylopericardium usually occurs secondary to trauma, cardiothoracic surgery, radiation therapy, or neoplasm of the mediastinum. Idiopathic chylopericardium is extremely rare. We report a case of primary chylopericardium in a 79-year-old male patient. Although pericardial window and thoracic duct ligation are the treatment of choice, the patient has been doing well for six months since video-assisted thoracoscopic pericardial window.

Excision of epicardial cyst originating from the left ventricle using video-assisted thoracoscopic surgery without cardiopulmonary bypass

Pericardial cysts are occasionally encountered and successfully excised using video-assisted thoracoscopic surgery (VATS). However, cardiac cysts originating from the epicardium are extremely rare. Herein, we report an epicardial cyst that was completely excised using VATS. The epicardial cyst had a feeding vessel from the left ventricle and was considered to originate from the left ventricle. To the best of our knowledge, this case is the first to report excision of an epicardial cyst using VATS.